Efficacy of laparoscopic hepatectomy for the treatment of hepatocellular carcinoma / 中华消化外科杂志

ABSTRACT

Objective To investigate the efficacy of laparoscopic hepatectomy for the treatment of hepatocellular carcinoma (HCC).Methods The clinical data of 30 HCC patients who were admitted to the Affiliated Cancer Hospital of Guangxi Medical University from January 2011 to December 2011 were retrospectively analyzed.All patients were divided into the laparoscopic hepatectomy (LH) group (10 patients) and open hepatectomy (OH) group (20 patients) according to the operation patterns and at the ratio of 1 ∶ 2.The degree of cirrhosis,size and location of tumor of the 2 groups were analyzed using the covariance analysis.The student t test was used for analysing the difference of the 2 groups.Results In the LH group,7 patients received laparoscopic nonanatomical liver resection,3 received anatomical resection of the left lateral lobe,no patient was converted to the hand assisted laparoscopic surgery or open surgery.In the OH group,14 patients received non-anatomical liver resection,and 6 received anatomical liver resection.The volume of blood loss of the LH group was (247 ± 235) ml,which was significantly lower than (408 ± 191)ml of the OH group (t =2.199,P ＜ 0.05).The mean postoperative fasting time,postoperative abdominal drainage time and duration of hospital stay of the LH group were (1.9 ±0.6) days,(3.2 ± 1.2) days and (8.9 ± 2.3) days,which were significantly shorter than (3.0 ± 1.6) days,(4.9±1.6)daysand (11.5±2.3)days of the OH group (t=2.149,2.917,2.921,P＜0.05).The levels of alanine aminotransferase (ALT) of the LH group at day 1,3,5 were (228 ± 100)U/L,(143 ± 51)U/L,(85 ±24) U/L,and the levels of aspartate aminotransferase (AST) of the LH group at day 1,3,5 were (196 ± 67)U/L,(90 ± 35) U/L,(46 ± 10) U/L.The levels of ALT of the OH group at day 1,3,5 were (557 ± 401) U/L,(414 ±397)U/L,(217 ± 199)U/L,and the levels of AST of the OH group at day 1,3,5 were (506 ±317)U/L,(178 ± 122) U/L,(71 ± 33) U/L.The time for hepatic function recovery of the LH group was significantly shorter than that of the OH group (t =3.675,3.001,2.073 ; 4.196,2.223,2.272,P ＜ 0.05).All the 30 patients were followed up for 3-15 months.The level of alpha fetoprotein of 1 patient in the LH group was increased at postoperative month 4,and the results of computed tomography showed multiple intrahepatic lesions.The patient was cured by intervention treatment.One patient of the OH group was diagnosed as with tumor recurrence at the resection margins and adjacent hepatic segments.The patient was cured by radiofrequency ablation,with no tumor recurrence.No tumor recurrence or metastasis was observed in the other patients.Conclusion Laparoscopic hepatectomy is a feasible,safe and minimally invasive approach for patients with HCC.